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Serrated colonic lesions. Current review 锯齿状结肠病变。目前的审查
Pub Date : 2023-03-15 DOI: 10.17650/2782-3202-2023-3-1-30-37
V. Vereshchak, I. N. Iurichev
Serrated lesions, as a rule, were considered benign and were likened to hyperplastic polyps by anatomists and gastroenterologists. These views persisted until about 2010. However, recent data showed that serrated lesions can potentially transform into colorectal cancer (CRC). The World Health Organization classification identifies 4 categories of serrated lesions: hyperplastic polyps, sessile serrated lesions, traditional serrated adenoma and unclassified serrated adenomas. Sessile serrated lesions with dysplasia and traditional serrated adenomas are the most common precursors of CRC. Development of CRC from serrated lesions occurs through two different molecular pathways, namely, sporadic microsatellite instability and CpG island methylator phenotype, and the latter is considered the main mechanism inactivating serrated CRC pathway. In contrast to adenoma–carcinoma pathway, APC-inactivating mutations are rare in serrated adenomas.
锯齿状病变通常被认为是良性的,解剖学家和胃肠病学家将其比作增生性息肉。这些观点一直持续到2010年左右。然而,最近的数据显示,锯齿状病变有可能转化为结直肠癌(CRC)。世界卫生组织的分类确定了4类锯齿状病变:增殖性息肉、无梗锯齿状病变、传统锯齿状腺瘤和未分类锯齿状腺瘤。不典型增生的无柄锯齿状病变和传统的锯齿状腺瘤是CRC最常见的前体。锯齿状CRC的发展通过两种不同的分子途径发生,即散发性微卫星不稳定性和CpG岛甲基化表型,后者被认为是灭活锯齿状CRC途径的主要机制。与腺瘤-癌途径相反,apc失活突变在锯齿状腺瘤中很少见。
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引用次数: 0
Algorithm of anemia correction in oncological patients 肿瘤患者贫血矫正算法
Pub Date : 2023-03-15 DOI: 10.17650/2782-3202-2023-3-1-68-72
J. Chekini
Anemia is one of the most frequent manifestations of oncological diseases and complications of cytotoxic chemotherapy. Development of this symptom is directly associated with decreased quality of life and possible stimulation of neoangiogenesis, increased tumor aggressiveness and decreased tumor sensitivity to chemotherapy and radiation. Current clinical trial data show decreased overall survival of patients with anemia. Modern methods of anemia correction in oncological diseases include exchange transfusion and administration of recombinant erythropoietins. Transfusion of erythrocyte-containing blood components allow to quickly replenish hemoglobin level, however there is risk of complications. A significant disadvantage of this method is short duration of the effect. Use of erythropoietins allows to reliably increase hemoglobin levels in 60–70 % of oncological patients with long-term effect. In recent years, use of erythropoietins in patients with oncological diseases became a topic of discussion due to possible negative effect on tumor through stimulation of erythropoietin receptors on neoplastic cells. This discussion led to recommendation of using erythropoietins only during chemotherapy in minimal doses.
贫血是肿瘤疾病最常见的表现之一,也是细胞毒性化疗的并发症。这种症状的发展与生活质量下降、可能刺激新生血管生成、肿瘤侵袭性增加和肿瘤对化疗和放疗的敏感性降低直接相关。目前的临床试验数据显示贫血患者的总生存率降低。肿瘤疾病中贫血的现代矫正方法包括换血和重组红细胞生成素的使用。输注含红细胞的血液成分可以迅速补充血红蛋白水平,但有并发症的风险。这种方法的一个显著缺点是效果持续时间短。使用促红细胞生成素可以可靠地提高60 - 70%的肿瘤患者的血红蛋白水平,并有长期效果。近年来,由于促红细胞生成素受体对肿瘤细胞的刺激可能对肿瘤产生负面影响,促红细胞生成素在肿瘤患者中的应用成为人们讨论的话题。这一讨论导致建议仅在化疗期间以最小剂量使用促红细胞生成素。
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引用次数: 0
Perioperative pain management in opioid-dependent patient with chronic pain: Current approaches and hidden dangers. Clinical case 阿片类药物依赖患者慢性疼痛的围手术期疼痛管理:目前的方法和隐患。临床病例
Pub Date : 2023-03-15 DOI: 10.17650/2782-3202-2023-3-1-38-47
V. E. Gruzdev, M. A. Anisimov, E. Glukhov
Severe chronic pain syndrome with high requirement for opioids is frequently complicated by opioid tolerance, hyperalgesia, and other side effects. Special complications occur during anesthesia for high-injury surgical interventions and in the postoperative period. Perioperative pain management in these patients requires planning, multimodal approach, combination methods, and prevention of complications including specific complications. This article describes a case of successful surgical treatment of pancreatic cancer in a patient with severe chronic pain syndrome, opioid tolerance, and hyperalgesia. Perioperative period was complicated by high requirement for epidural pain management and use of adjuvants, acute strangulating intestinal obstruction on day 6 of the postoperative period. The authors had to differentiate between pain syndrome and abstinence multiple times and encountered the problem of tachyphylaxis to local anesthetics. Due to thought-out and flexible system of combination multimodal pain management, pain syndrome was relieved, and the patient was discharged in satisfactory condition without the need for opioids.
阿片类药物高需要量的严重慢性疼痛综合征常并发阿片类药物耐受性、痛觉过敏等副作用。特殊的并发症发生在高损伤手术干预麻醉和术后阶段。这些患者的围手术期疼痛管理需要计划、多模式入路、联合方法和预防并发症,包括特异性并发症。这篇文章描述了一个成功的手术治疗胰腺癌患者的严重慢性疼痛综合征,阿片类药物耐受性和痛感过敏。围手术期对硬膜外疼痛的处理和辅助药物的使用要求较高,术后第6天出现急性绞窄性肠梗阻。作者不得不多次区分疼痛综合征和戒断,并遇到局麻药的快速反应问题。由于多模式联合疼痛管理系统的深思熟虑和灵活,疼痛综合征得到缓解,患者出院情况满意,无需阿片类药物。
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引用次数: 0
Successful treatment of advanced purulent peritonitis. Clinical case 成功治疗晚期化脓性腹膜炎。临床病例
Pub Date : 2023-03-14 DOI: 10.17650/2782-3202-2023-3-1-16-21
E. Glukhov, M. M. Davydov, A. A. Filatov, M. Shogenov, E. V. Dementieva
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引用次数: 0
Molecular genetic determinants of arterial thrombosis in patients with thoracoabdominal malignant tumors 胸腹恶性肿瘤患者动脉血栓形成的分子遗传决定因素
Pub Date : 2022-12-14 DOI: 10.17650/2782-3202-2022-2-4-46-55
A. A. Korolyova, S. Gerasimov, L. Lyubchenko
Background. Acute ischemic cerebral circulation disorder and myocardial infarction occupy one of the first places among the causes of postoperative mortality in patients with malignant tumors of thoracoabdominal localization. The issue of the role of molecular genetic factors of cardiovascular risk in the development of these complications has not been resolved at present.Objective. To analyze the effect of polymorphisms of hemostasis system genes on the development of coronary artery and cerebral artery thrombosis in patients with malignant tumors of thoracoabdominal localization.Materials and methods. The study included 163 patients operated in the Oncological Department of Surgical Methods of Treatment No. 11 (Thoracic Oncology) of the N.N. Blokhin National Medical Research Center of Oncology in 2018-2019. Two study groups consisted of patients with myocardial infarction (n = 62) and ischemic stroke (n = 24) in the perioperative period or in the anamnesis. The data of patients with a history of both myocardial infarction and ischemic stroke (n = 4) were taken into account in both groups. The control group (n = 81) included patients who had no severe concomitant cardiovascular pathology, including a family history. A molecular genetic study to determine polymorphisms of the genes of the hemostasis system was performed in the Laboratory of Clinical Oncogenetics of the N.N. Blokhin National Medical Research Center of Oncology using the reagents “Cardiogenetics of Thrombophilia” (DNA Technology LLC, Russia; RU No. FSR 2010/08414 dated 11/22/2016).Results. In patients with malignant tumors of thoracoabdominal localization who have suffered a myocardial infarction, in comparison with patients without cardiovascular pathology, a statistically significant difference in the frequency of carriage of homozygous variants of the genes FGB (χ2 = 8.18, p = 0.005), ITGA2 (χ2 = 9.48, p = 0.003), PAI-1 (χ2 = 4.45, p = 0.035), heterozygous forms of genes F5 (χ2 = 4.0, p = 0.046), ITGA2 (χ2 = 14.72, p <0.001), ITGB3 (χ2 = 4.28, p = 0.039), as well as the total frequency of genetic aberrations in these genes. In the group of patients who suffered an ischemic stroke, a statistically significant difference was determined relative to the control group in the frequency of carriage of the heterozygous variant of the mutation in the F2 gene (χ2 = 6.881, p = 0.009), the homozygous form of the mutation of the ITGA2 gene (χ2 = 15.724, p <0.001), the heterozygous variant of the mutation in the ITGB3 gene (χ2 = 3.861, p = 0.05), as well as the total frequency of carrying mutations in these genes. The study did not obtain a significant difference in the studied and control groups with respect to the frequency of polymorphism carriers G/A of the F7 gene (coagulation factor VII) and G/T of the F13 gene (coagulation factor XIII) associated with a reduced risk of thrombotic conditions. In all patients who had a myocardial infarction, and in 91.7 % of cases, several procoagulant p
背景。急性缺血性脑循环障碍和心肌梗死在胸腹定位恶性肿瘤患者术后死亡原因中占据首位。心血管危险分子遗传因素在这些并发症发生中的作用问题目前尚未解决。分析止血系统基因多态性对胸腹恶性肿瘤患者冠状动脉和脑动脉血栓形成的影响。材料和方法。本研究纳入了2018-2019年在N.N. Blokhin国家肿瘤医学研究中心第11外科治疗方法(胸部肿瘤)肿瘤科手术的163例患者。两组患者分别为围手术期或健全期心肌梗死(n = 62)和缺血性脑卒中(n = 24)。两组均考虑有心肌梗死和缺血性脑卒中病史的患者(n = 4)的资料。对照组(n = 81)包括无严重合并心血管疾病的患者,包括家族史。在N.N. Blokhin国家肿瘤医学研究中心的临床肿瘤遗传学实验室,使用试剂“血栓形成的心脏遗传学”(DNA技术有限责任公司,俄罗斯;俄文。FSR 2010/08414(日期:2016年11月22日)。恶性肿瘤患者的胸腹的本地化了心肌梗死患者相比无心血管病理、一个统计上的显著差异的频率运输基因变异纯合子的FGB(χ2 = 8.18,p = 0.005), ITGA2(χ2 = 9.48,p = 0.003), PAI-1(χ2 = 4.45,p = 0.035),杂合的基因形式的F5(χ2 = 4.0,p = 0.046), ITGA2(χ2 = 14.72,p < 0.001), ITGB3(χ2 = 4.28,p = 0.039),以及这些基因中基因畸变的总频率。组的患者遭受缺血性中风,统计上的显著差异是决定相对于对照组的运输频率的杂合的变体在F2基因突变(χ2 = 6.881,p = 0.009), ITGA2的突变基因的纯合子(χ2 = 15.724,p < 0.001), ITGB3中的突变基因的杂合的变体(χ2 = 3.861,p = 0.05),以及总携带这些基因突变的频率。在F7基因(凝血因子VII)多态性携带者G/ a和F13基因(凝血因子XIII)多态性携带者G/T的频率与血栓形成风险降低相关方面,研究未发现实验组和对照组之间存在显著差异。在所有心肌梗死患者中,91.7%的病例中,在缺血性卒中患者的基因型中发现了几种促凝剂多态性;无心血管疾病组该指标为53%,组间差异有统计学意义(χ2 = 39.61, p <0.001;χ2 = 11.685, p <0.001)。基于高血栓形成风险相关因素的分子遗传学研究结果,发现发生心肌梗死的胸腹定位肿瘤患者中多态性标记F5 G1691A、FGB G(-455) a、ITGA2 C807T、ITGB3 T1565C、PAI-1 4G(-675)5G的发生频率与发生缺血性脑卒中的胸腹定位肿瘤患者中F2 G20210A、ITGA2 C807T、ITGB3 T1565C的发生频率有统计学意义。与无心血管病变的癌症患者比较。所进行的研究数据使得确定围手术期心血管并发症风险增加的肿瘤患者群体并采取额外措施预防血栓性并发症成为可能。
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引用次数: 0
A case of combination treatment of femoral osteosarcoma 综合治疗股骨骨肉瘤1例
Pub Date : 2022-12-14 DOI: 10.17650/2782-3202-2022-2-4-56-62
A. A. Filimonov, N. M. Kutakov, D. Chekini, E. M. Musaev, A. O. Akhov, A. G. Zhukov, O. L. Timofeeva, F. М. Abbasbeyli, Yu. E. Ryabukhina, P. A. Zeynalova, A. Fedenko, E. K. Ibragimov
Osteosarcomas are rare tumors with aggressive biology. It is important to refer such patients to a high-volume center, where an accurate diagnosis and optimal treatment are more likely to be performed. In contrast to Ewing's sarcoma, conventional osteosarcomas are believed to be generally resistant to radiation therapy, and the main treatment modalities are surgery and chemotherapy. In this clinical case, we demonstrate the efficacy of combined treatment of osteosarcoma of the femur.Preoperative chemotherapy allowed to evaluate tumor sensitivity to systemic treatment in vivo and optimize adjuvant treatment after R0 resection which allowed to achieve complete clinical response to treatment.
骨肉瘤是一种罕见的具有侵袭性的肿瘤。将此类患者转诊到大容量中心是很重要的,在那里更有可能进行准确的诊断和最佳治疗。与尤文氏肉瘤相比,传统骨肉瘤被认为对放射治疗普遍具有耐药性,主要的治疗方式是手术和化疗。在这个临床病例中,我们展示了联合治疗股骨骨肉瘤的疗效。术前化疗可以在体内评估肿瘤对全身治疗的敏感性,并优化R0切除后的辅助治疗,从而实现对治疗的完全临床反应。
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引用次数: 0
Prevention of induced nausea and vomiting in patients with malignant blood disorders. Experience of using netupitant/palonosetron (Akynzeo) 恶性血液病患者恶心呕吐的预防。使用尼吡坦/帕洛诺司琼(Akynzeo)的经验
Pub Date : 2022-12-14 DOI: 10.17650/2782-3202-2022-2-4-71-77
Yu. E. Ryabukhina, P. A. Zeynalova, O. L. Timofeeva, F. М. Abbasbeyli
Supporting therapy is a necessary component of successful antitumor treatment in patients with both solid tumors and malignant blood disorders. Adherence to administration protocol for antiemetic drugs aimed at prevention of induced gastrointestinal complications (nausea and vomiting), allows to improve patients' quality of life and treatment compliance. Development of a combination antiemetic drug (netupitant/palonosetron) simultaneously affecting 2 main mechanisms of nausea and vomiting as well as its easy administration allowed to significantly improve control of these complications in patients with solid tumors and patients with malignant blood disorders.We present a literature review on the effectiveness of netupitant/palonosetron and describe our own experience of using this antiemetic drug for prevention of chemotherapy-induced nausea and vomiting.
支持治疗是实体瘤和恶性血液疾病患者成功抗肿瘤治疗的必要组成部分。遵守止吐药物的给药方案,旨在预防诱发的胃肠道并发症(恶心和呕吐),可以提高患者的生活质量和治疗依从性。一种联合止吐药物(尼妥吡坦/帕洛诺司琼)的开发同时影响恶心和呕吐的两种主要机制,并且易于给药,可以显著改善实体瘤和恶性血液疾病患者这些并发症的控制。我们对尼吡坦/帕洛诺司琼的有效性进行了文献综述,并描述了我们自己使用这种止吐药物预防化疗引起的恶心和呕吐的经验。
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引用次数: 0
Use of transoral ultrasonography technique in tongue cancer: Advantages and disadvantages 经口超声技术在舌癌诊断中的应用:利弊
Pub Date : 2022-12-14 DOI: 10.17650/2782-3202-2022-2-4-41-45
G. Allakhverdieva, A. Mudunov, A. Batsev
Aim. To evaluate advantages and disadvantages of transoral ultrasonography (US) in tongue cancer.Materials and methods. US was performed in 165 patients between the ages of 15 and 85 years with malignant tumors of the mobile tongue (74 (44.9 %) women, 91 (55.1 %) men).Among 165 patients, 144 had primary tongue tumor. The study also included 21 (12.7 %) patients with recurrent tumor which clinically could be represented by a true recurrence (tumor development 6 months after the end of treatment) or by continued growth (tumor development less than 6 months after the end of treatment). The study included patients with tongue tumors Т1 - 50 (30.3 %) patients, Т2 - 78 (47.3 %) patients, Т3 - 16.4 % of patients, Т4 - 6.1 % of patients.Three types of approach to tongue tumor visualization were used: submandibular, transoral, and transbuccal with a standard linear transducer (4-9 MHz) and intraoperative linear transducer (5-14 MHz). In total in 165 patients with tongue tumors, 147 (89.1 %) transoral US, 86 (52.1 %) submandibular US and 25 (15.2 %) transbuccal US examinations were performed.Results. Among 165 patients, agreement between the sizes measured using US and histological examination was observed in 142 (86.1 %) patients taking into account 15 % error.With increasing tumor thickness and, correspondingly, T criterion, increased frequency of agreement between US data and histological data was observed. Thus, for T1 stage frequency of agreement with US data was observed in 61.8 % of cases, for Т2 stage in 81.1 % of cases, for Т3 stage in 93.8 %, and for Т4 stage agreement was observed in 100 % of cases.Frequency of agreement with histological data in evaluation of tongue tumor thickness for transoral approach was significantly higher than for submandibular approach (р = 0.014). Transoral technique was more accurate for measurement of thickness of primary tumors - 80.3 % of results agreed with histological examination, and for recurrences frequency of agreement was only 33.3 %. Submandibular approach for primary tumors showed accurate measurements only in 67.6 % of cases, in recurrent tumors in 58.3 % of cases. Transbuccal approach also showed higher measurement accuracy for tumor thickness in primary patients (70.0 %) compared to recurrent tumors (40.0 %).Conclusion. Use of transoral ultrasonography significantly improves clinical staging of tongue tumors at the preoperative stage.
的目标。目的探讨经口超声检查在舌癌诊断中的利弊。材料和方法。我们对165例15 ~ 85岁的舌部恶性肿瘤患者进行了US检查,其中74例(44.9%)为女性,91例(55.1%)为男性。165例患者中有144例原发舌瘤。该研究还包括21例(12.7%)复发性肿瘤患者,这些患者在临床上可以表现为真正的复发(治疗结束后6个月肿瘤发展)或持续生长(治疗结束后不到6个月肿瘤发展)。研究对象为舌肿瘤患者Т1 ~ 50例(30.3%)、Т2 ~ 78例(47.3%)、Т3 ~ 16.4%、Т4 ~ 6.1%。使用标准线性换能器(4-9 MHz)和术中线性换能器(5-14 MHz)三种方式进行舌肿瘤显像:下颌下、经口和经颊。在165例舌肿瘤患者中,经口超声检查147例(89.1%),下颌骨超声检查86例(52.1%),经颊超声检查25例(15.2%)。在165例患者中,考虑到15%的误差,142例(86.1%)患者使用US测量的尺寸与组织学检查一致。随着肿瘤厚度的增加,相应的,T标准的增加,我们观察到US数据与组织学数据之间的一致性增加。因此,T1阶段与美国数据一致的频率在61.8%的病例中观察到,Т2阶段为81.1%的病例,Т3阶段为93.8%,Т4阶段为100%的病例。经口入路评价舌瘤厚度与组织学资料吻合的频率显著高于下颌下入路(χ = 0.014)。经口技术对原发肿瘤的厚度测量更为准确,80.3%的结果与组织学检查一致,而复发率仅为33.3%。下颌下入路对原发肿瘤的测量准确度仅为67.6%,对复发肿瘤的测量准确度为58.3%。经颊入路对原发患者的肿瘤厚度测量准确率(70.0%)高于复发患者(40.0%)。术前应用经口超声检查可明显改善舌肿瘤的临床分期。
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引用次数: 0
A rare cause of mechanical jaundice. Clinical case 机械性黄疸的罕见病因。临床病例
Pub Date : 2022-12-14 DOI: 10.17650/2782-3202-2022-2-4-63-70
I. N. Iurichev, V. Vereshchak, I. V. Platitsyn
Causes of mechanical jaundice are extremely varied and can be either malignant or benign. The main causes of malignant nature are cholangiocarcinoma and pancreatic ductal adenocarcinoma, while common benign causes of obstructive mechanical jaundice are choledocholithiasis and chronic pancreatitis. Rarer causes of this severe complication are not extensively described in literature.
机械性黄疸的病因多种多样,可以是恶性的,也可以是良性的。恶性性质的主要原因是胆管癌和胰管腺癌,而梗阻性机械黄疸常见的良性原因是胆总管结石和慢性胰腺炎。这种严重并发症的罕见原因在文献中没有广泛描述。
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引用次数: 0
Giant perianal seborrheic keratosis as a manifestation of the Leser-Trelat syndrome 巨大的肛周脂溢性角化病是Leser-Trelat综合征的一种表现
Pub Date : 2022-12-13 DOI: 10.17650/2782-3202-2022-2-4-27-33
A. Rasulov, A. E. Kulikov, J. Madyarov, Z. Rasulov, L. A. Shestakova, A. G. Zhukov, Yu. E. Lvova, R. A. Rasulov
Seborrheic keratosis is the most common benign tumor of the epidermis. Rarely the tumor develops in the perineal area and quite rarely is large. For the Leser-Trelat syndrome these tumors is a marker of a malignant disease even before the symptoms are appeared, as well as a manifestation of the paraneoplastic process. In our case report, a giant perianal seborrheic keratoma was the reason for the clinical examination of the patient and stomach cancer was detected. As a result, we demonstrated a successful experience of surgical treatment of seborrheic keratoma of the perianal area and determined an algorithm for the treatment of stomach cancer.
脂溢性角化病是最常见的表皮良性肿瘤。肿瘤很少发生在会阴区,也很少很大。对于Leser-Trelat综合征,这些肿瘤甚至在症状出现之前就是恶性疾病的标志,也是副肿瘤过程的表现。在我们的病例报告中,一个巨大的肛周脂溢性角化瘤是患者临床检查的原因,并检测出胃癌。因此,我们展示了手术治疗肛周脂溢性角化瘤的成功经验,并确定了治疗胃癌的算法。
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引用次数: 0
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